What would be the best long-term treatment for my hollow under eyes? (Photos)

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best,
Dr. Emer

You would benefit from a lower blepharoplasty. This will release the orbital fat to eliminate the horizontal wrinkles.

Best Wishes,

Gary Horndeski, M.D.

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. Based on your concerns, I recommend treatments with Botox and dermal filler. Botox injections can help reduce the appearance of undereye jelly rolls, which are caused by muscle contraction and skin laxity. By targeting the orbicularis oculi muscle with Botox, the movement that contributes to the jelly roll can be minimized, leading to smoother skin and a more rested appearance. Dermal fillers, such as hyaluronic acid-based products, are used to treat undereye hollows or tear troughs. These hollows can create a shadowed appearance and make the eyes look tired. By carefully injecting filler into the tear trough area, volume is restored, effectively reducing the hollows and creating a smoother transition between the lower eyelid and cheek. Combining these treatments can provide comprehensive rejuvenation for the undereye area, addressing both dynamic wrinkles and volume loss. I hope this helps and best of luck!

At least from the photo provided, it appears that the rolls under the eyes appear with smiling. If so, these "jelly rolls" can typically be easily treated via the use of two or three microdroplets of Botox placed into the "belly" of the muscle right below eye that is responsible for this. I have personally been performing this technique for this problem for over thirty years with gratifying results.
Jumping into surgery, especially when younger, is not without its significant expense, significant post-surgical downtime, and potential risks. So, heading straight for surgery, you might consider a consultation with an experienced, board certified cosmetic dermatologist.

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, temporary fillers, micro-fat grafts, and blepharoplasties. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

In a patient with your inherited anatomy, a blepharoplasty including micro-fat grafts to the tear troughs will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you what to do without seeing photos and without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Based on your one posted photo there appears to be a tear trough deformity with hyperactive lower eyelid muscle. A combination of capital H capital a filler, Vella, with microdose Botox might help improve this temporarily. Expect fee to range from 1000 to $2500. Best of virtual consult with

We don’t make assessments based on what the face looks like with contraction of facial muscles.
We make assessments and typically design treatment plans based on what the face looks like under static conditions without facial expression.
This area is inherently complex and not at all easy to properly assess or treat.
Expect different providers to have different opinions.
That is often the case when there is no one single best treatment option.
I suggest scheduling a few in person consultations with local plastic surgeons, facial plastic surgeons or oculoplastic surgeons.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of previous patients went similar facial characteristics to your own created.
Bring a quality set of facial pictures taken the same way plastic surgeons take before and after pictures.
Avoid taking pictures With facial expression.
Use pictures of yourself as reference when reviewing before and after pictures.
Don’t rely on memory or looking in the mirror when reviewing before and after pictures.
Best,
Mats Hagstrom MD